Background: The early identification of patients at risk of clinical deterioration is of interest considering the timeline of COVID-19 after the onset of symptoms. Objective: The aim of our study was to evaluate the usefulness of testing serum IL-6 and other serological and clinical biomarkers, to predict a short-term negative clinical course of patients with noncritical COVID-19. Methods: A total of 208 patients with noncritical COVID-19 pneumonia at admission were consecutively enrolled. Clinical and laboratory findings obtained on admission were analyzed by using survival analysis and stepwise logistic regression for variable selection. Three-day worsening as outcome in a logistic model to generate a prognostic score was used. Results: Clinical worsening occurred in 63 patients (16 = died; 39 = transferred to intensive care unit; 8 worsening of respiratory failure). Forty-five of them worsened within 3 days after admission. The risk of clinical worsening was progressively enhanced along with increasing quartiles of IL-6 levels. Multivariate analysis showed that IL-6 (P =.005), C-reactive protein (CRP) (P =.003), and SaO2/FiO2 (P =.014) were the best predictors for clinical deterioration in the first 3 days after admission. The combined score yielded an area under the curve = 0.88 (95% confidence interval: 0.83-0.93). A nomogram predicting the probability of 3-day worsening was generated. The score also showed good performance for 7-day and 14- or 21-day worsening and in predicting death occurring during all the follow-up. Conclusions: Combining IL-6, CRP, and SaO2/FiO2 in a score may help clinicians to identify on admission those patients with COVID-19 who are at high risk for a further 3-day clinical deterioration.

Prompt Predicting of Early Clinical Deterioration of Moderate-to-Severe COVID-19 Patients: Usefulness of a Combined Score Using IL-6 in a Preliminary Study / Vultaggio A.; Vivarelli E.; Virgili G.; Lucenteforte E.; Bartoloni A.; Nozzoli C.; Morettini A.; Berni A.; Malandrino D.; Rossi O.; Nencini F.; Pieralli F.; Peris A.; Lagi F.; Scocchera G.; Spinicci M.; Trotta M.; Mazzetti M.; Parronchi P.; Cosmi L.; Liotta F.; Fontanari P.; Mazzoni A.; Salvati L.; Maggi E.; Annunziato F.; Almerigogna F.; Matucci A.. - In: JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE. - ISSN 2213-2198. - ELETTRONICO. - 8:(2020), pp. 2575-2581.e2. [10.1016/j.jaip.2020.06.013]

Prompt Predicting of Early Clinical Deterioration of Moderate-to-Severe COVID-19 Patients: Usefulness of a Combined Score Using IL-6 in a Preliminary Study

Vultaggio A.;Virgili G.;Lucenteforte E.;Bartoloni A.;Malandrino D.;Rossi O.;Nencini F.;Peris A.;Lagi F.;Scocchera G.;Spinicci M.;Parronchi P.;Cosmi L.;Liotta F.;Fontanari P.;Mazzoni A.;Salvati L.;Maggi E.;Annunziato F.;Almerigogna F.;Matucci A.
2020

Abstract

Background: The early identification of patients at risk of clinical deterioration is of interest considering the timeline of COVID-19 after the onset of symptoms. Objective: The aim of our study was to evaluate the usefulness of testing serum IL-6 and other serological and clinical biomarkers, to predict a short-term negative clinical course of patients with noncritical COVID-19. Methods: A total of 208 patients with noncritical COVID-19 pneumonia at admission were consecutively enrolled. Clinical and laboratory findings obtained on admission were analyzed by using survival analysis and stepwise logistic regression for variable selection. Three-day worsening as outcome in a logistic model to generate a prognostic score was used. Results: Clinical worsening occurred in 63 patients (16 = died; 39 = transferred to intensive care unit; 8 worsening of respiratory failure). Forty-five of them worsened within 3 days after admission. The risk of clinical worsening was progressively enhanced along with increasing quartiles of IL-6 levels. Multivariate analysis showed that IL-6 (P =.005), C-reactive protein (CRP) (P =.003), and SaO2/FiO2 (P =.014) were the best predictors for clinical deterioration in the first 3 days after admission. The combined score yielded an area under the curve = 0.88 (95% confidence interval: 0.83-0.93). A nomogram predicting the probability of 3-day worsening was generated. The score also showed good performance for 7-day and 14- or 21-day worsening and in predicting death occurring during all the follow-up. Conclusions: Combining IL-6, CRP, and SaO2/FiO2 in a score may help clinicians to identify on admission those patients with COVID-19 who are at high risk for a further 3-day clinical deterioration.
2020
8
2575
2581.e2
Goal 3: Good health and well-being for people
Vultaggio A.; Vivarelli E.; Virgili G.; Lucenteforte E.; Bartoloni A.; Nozzoli C.; Morettini A.; Berni A.; Malandrino D.; Rossi O.; Nencini F.; Pieralli F.; Peris A.; Lagi F.; Scocchera G.; Spinicci M.; Trotta M.; Mazzetti M.; Parronchi P.; Cosmi L.; Liotta F.; Fontanari P.; Mazzoni A.; Salvati L.; Maggi E.; Annunziato F.; Almerigogna F.; Matucci A.
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1213127
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